This document discusses endometrial carcinoma (cancer of the uterine lining). It covers the types of endometrial hyperplasia (non-cancerous overgrowth), types of endometrial cancer including the most common type, and clinical features such as postmenopausal bleeding. Investigations like transvaginal ultrasound, endometrial biopsy and MRI are discussed. Treatment options include surgery such as hysterectomy for early stages and hormone therapy or radiation for some pre-cancerous lesions or advanced cases. Prognosis depends on cancer stage, with 5-year survival rates ranging from 75% for stage I to 10% for stage IV disease.

1. ENDOMETRIAL CARCINOMA
AHMED FARRASYAH BIN MOHD KUTUBUDIN
071303511
BATCH 24
GROUP A2

2. 1. What are types of endometrial hyperplasia?
2. What are types of endometrial ca and the
commonest type?
3. What are the clinical features ?
4. What are the investigations that should be done?
5. In which lesion spontaneous regression is possible?
6. What is mode of treatment?

3. 1. Simple endometrial hyperplasia without atypia
Complex endometrial hyperplasia without atypia
Simple endometrial hyperplasia with atypia
Complex endometrial hyperplasia with atypia
2. adenocarcinoma,serous ca,clear cell adenocarcinoma,secondary
metastasis
3. postmenopausal bleed,offensive vaginal discharge,pelvis discomfort
4. tvs,pelvic examination,endometrial biopsy(pipelle
sampling),hysteroscopy,cxr,MRI
5. simple hyperplasia without atypia
6. surgical/hormonal
Thorough intraperitoneal exploration
Peritoneal washing
Extrafascial hysterectomy and bilateral salphingoophorectomy
Pelvic with or without paraaortic lymphadenectomy
Omentectomy- in advanced cases if omentum is involved

4. THANK YOU

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Diagnosis:
Primary assessment in all cases is with transvaginal
ultrasound and pelvic examination.
All postmenopausal patients with an endometrial
thickness >5mm or persistent bleeding despite a normal
endometrial thickness should have an endometrial biopsy
If the endometrium is difficult to identify then
hysteroscopy should be considered.
The value of endometrial thickness in perimenopausal
bleeding is questionable as the thickness range is
variable.
Hysteroscopy should be used as a diagnostic tool only
when ultrasound results are inconclusive

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Clinical features
>90%: postmenopausal bleeding.
Usually 20% of those who come with post
menopausal bleed will have a carcinomatous
origin. Out of those, 50% will be due to
endometrial carcinoma.
offensive vaginal discharge
Discomfort in the pelvis (not always)
Uterine enlargement in advanced disease
Vaginal metastases particularly in the lower
third.

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INTRODUCTION
Endometrial carcinoma is the commonest
gynaecological cancer in the developed world with
a rising incidence in postmenopausal women.
The crude incidence of endometrial carcinoma in
the European Union is 16 cases/100 000
women/year
Uterine cancer effects the lining of the uterus
(endometrium). It is the fourth most common
cancer in women in Peninsular Malaysia.

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Endometrial
carcinoma
Type 1
- Related to hyperestrogenism associated
with endometrial hyperplasia
- Frequent expression of estrogen and
progesterone
- Younger age
Type 2
- Unrelated to estrogen associated with
atrophic endometrium
- Lack of estrogen and progesterone
receptors
- Older age

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Risk factors:
age: peak (65-75 years old)
Obesity[rcog]
nulliparity
late menopause
polycystic ovary syndrome
Estrogen replacement therapy
Chronic diseases: DM, hypertension
family history of endometrial, ovarian or intestinal
malignancy
past history of breast, ovarian or intestinal malignancy.

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Endometrial hyperplasia
Classification of endometrial hyperplasia %
Simple endometrial hyperplasia without atypia 1
Complex endometrial hyperplasia without atypia 3
Simple endometrial hyperplasia with atypia 8
Complex endometrial hyperplasia with atypia 29

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Histopathology:
1. Endometriod adenocarcinoma
Most common type ~75-80%
2. Serous carcinoma
~10% of all cases
Has papillary growths which resembles serous
carcinoma of ovary and Fallopian tubes
3. Other cell types
4%-Clear cell adenocarcinoma
Secondary metastasize from breast, stomach, colon,
pancreas, kidney, ovary

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Investigations:
After confirming the diagnosis the objectives
of further investigations are to
determine the extent of disease
determine suitable treatment.
Endometrial biopsy using pipelle sampling
with sensitivity of 81-99% and specificity of
98%.
A chest X-ray is essential.
An MRI scan: lymph node metastases and the
presence of occult cervical involvement.

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Treatment: (premalignant lesions)
Spontaneous regression is possible in
simple hyperplasia without atypia (72%
cases)
Most important determinant for the choice of
treatment is presence of atypia.
Treatment of others either
hormonally/surgically

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Endometrial hyperplasia
Simple hyperplasia
Expectant/
progesterone Rx
Complex hyperplasia
premenopause
Progesterone Rx,
USG, repeat
curettage
postmenopause
Progesterone Rx,
USG, repeat
curettage/
hysterectomy
Atypical hyperplasia
prememopause
Progesterone Rx,
USG, repeat
curettage/
hysterectomy
postmenopause
Simple
hysterectomy

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Surgical
The most important mode of treatment
Consists of:
Maylard’s incision (if early) or midline (if advanced)
Thorough intraperitoneal exploration
Peritoneal washing
Extrafascial hysterectomy and bilateral
salphingoophorectomy
Peliv with or without paraaortic lymphadenectomy
Omentectomy- in advanced cases if omentum is
involved.

16. radiotherapy
Only applied adjuvant or if patient is
unstable for surgical treatment
Indications include
Grade 3 tumours
Myometrial invasion >50%
Histology- clear cell ca of uterine papillary
serous carcinoma
Cervical involvment
Lymph node involvment
Lymphovascular space involvment

17. Chemotherapy
Use of adjuvant chemotherapy has been used in recent years
The combination of doxorubicin + cisplatin + paclitaxel
significantly improve overall survival
Because of toxicity considerations, an alternative option may
be the combination of carboplatin and paclitaxel
HRT: continuous combined therapy may be theoretically most
appropriate for post operative patients with persistent
climacteric symptoms (low dose progestin).

18. Prognosis:
STAGE 5 YEAR SURVIVAL (%)
I 75
II 58
III 30
IV 10

19. REFERENCE
1. Endometrial cancer incidence statistic, Srdjan Saso, published 6/7/11
http://www.bmj.com/content/343/bmj.d3954, last viewed on 26/6/13.
2. Incidence of endometrial cancer in Malaysia(2007): http://www.malaysiaoncology.org/article.php?aid=297
3. The New FIGO Staging for Carcinoma of the Vulva, Cervix, Endometrium, and Sarcomas (2009)
http://www.medscape.com/viewarticle/722721
4. Karlsson B, Granberg S, Wikland M et al. (1995) Transvaginal ultrasonography of the endometrium in women
with postmenopausal bleeding – a Nordic multicentre study. Am J Obstet Gynecol, 172, 1488-94.
5. Clark TJ, Barton PM, Coomarasamy A et al. (2006) Investigating postmenopausal bleeding for endometrial cancer:
cost-effectiveness of initial diagnostic strategies. Br J Obstet Gynaecol, 113, 502-10.
6. Creutzberg CL, van Putten WL, Koper PC et al. (2000) Surgery and postoperative radiotherapy versus surgery alone
for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Lancet; 35,
1404-11.
7. North Wales Cancer Guidelines, Endometrial Cancer (April 2008)

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THANK YOU